Question

Y 24 GYNECOLOGICAL AND OBSTETRICAL SURGERY 595 8. During laparoscopy and removal of tissue, such as a more cellated tumor or an ovarian cyst, a specimen retrieval bag is used to remove the specimen from the abdomen. What size trocar is needed when a specimen retrieval bag is used? 9. Radical abdominal and pelvic procedures, such as pelvic exenteration and the Whipple procedure, are performed much less often now than they were several years ago. What do you think are the reasons for this? 10. Consider a situation in which you are called to scrub for an emergency cesarean section. What is the minimum instru- mentation and equipment you should have ready when the mother is brought into the operating room? Assume that your instrument tray is open and the Mayo stand is draped, but you have no instruments on the Mayo stand. The sur- geon is ready to start; you have approximately 4 minutes to prepare for abdominal entry and removal of the baby. REFERENCES Quality. Cerclage for the manage-

Answer 1

Q No. 8 ) Laparoscopic Gynaecology : This is an advanced surgical procedure where the surgeon uses laparoscope, a camera to visualize all the abdominal parts with out opening the abdomen.This procedure diagnoses many conditions such as fibroids, cysts, endometriosis etc. and those can be removed. Even hysterectomy and tubal ligation is performed.

Gynaecological Laparoscopic Instruments.

• Needles and Needle holders
• Suction tubes
• Trocar and cannula
• Retractors
• Scissors
• Probes
• Silastic Rings

There are different sizes of specimen bags used for laparoscopic surgeries. Mostly used size for specimen collection in gynaecology is 10 to 15 cms. For collection of masses, cysts and also specimen 10 cms bag can be used.

And the trocar used for this bag is 10 mm.

Q.No 9 ) Pelvic Exenteration : This is a radiological procedure or surgery that removes the pelvic parts. In gynaecology this was in practice for the cancers of uterus, fallopian tubes, cervix which also includes all other pelvic parts.

Whipple procedure : This is one of the surgeries which is considered to be a complex procedure where neoplasms or cancerous cysts can be removed.

Complications of Whipple procedure and Pelvic Exenteration:

• Whipple procedure had not proved it self to have a good prognosis and the survival rate after the Whipple is very less.Even though the tumors were removed in the located parts the other spreaded tumors could not be removed and it leads to death.
• Pelvic exenteration also proved itself to be not good with the increased chances of death. It has complications such as Sepsis, wound infections, Severe renal failures, Defecation problems that results in colostomy,also pelvic infections.

​​​​​​​These are the reasons for lesser use of the above surgical procedures.

Q.No 10 ) Considering as Scrub Nurse for Emergency Caesarean Section , after drawing Mayo stand found that no instruments on the stand. Minimum instrumentation to be ready by the time mother brought to the surgery are

• Scalpel blade
• Artery forceps
• Two taped large swabs
• Curved Scissors
• Doyens Retractor